Uterine Artery Embolisation in the Management of Fibroids. Clinical recommendations on the use of uterine artery embolisation (UAE) in the management of fibroids.
This is the third edition of this document, and is a joint report from the RCOG and the Royal College of Radiologists (RCR).
Aterial embolisation has been used over the last three decades as a method of treating gynaecological haemorrhage in a variety of clinical situations, including postpartum haemorrhage, bleeding after caesarean section and bleeding following gynaecological surgery. The technique was subsequently used for the management of arteriovenous malformations of the genital tract and in gestational trophoblastic disease.
Ravina et al. first used arterial embolisation to treat fibroids in 1991, publishing their series in 1991. In 2000, a Joint Working Party of the RCOG and the RCR was established to issue guidance on uterine artery embolisation (UAE), which at that time was in its infancy with fewer than 7000 procedures undertaken worldwide. Since the publication of that guidance, the procedure has become well established and over 100,000 cases have now been performed worldwide. The evidence from national registries and randomised trials has demonstrated that UAE has good short- and medium-term success rates with acceptable morbidity and very low mortality.
UAE is now a widely accepted option for the treatment of symptomatic fibroids and has been recognised as such by the National Institute of Health and Care Excellence (NICE) in its guideline for heavy menstrual bleeding.
This third edition of the RCR/RCOG guideline updates the guidance issued in the previous edition. It is intended to provide information for women interested in undergoing UAE and guidelines for clinicians involved in their care.